Person-Centred Therapy

The Focusing-Oriented Approach

Campbell Purton

• Publisher: Bloomsbury Academic
• Year: 2017
• ISBN:
  9781350317147
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Since its beginnings in the 1950s, the person-centred approach to therapy has developed in many ways. In this important new text, Campbell Purton introduces the 'focusing' approach of Eugene Gendlin. The book discussed Gendlin's theoretical innovations and their implications for clinical practice. It throws light on the relationship between the various schools of therapy, and on the relationship between therapy and such areas as ethics and spirituality. It will be essential reading for students and practioners of person-centred therapy.

1

Rogers and the Development of Person-Centred Therapy

Rogers’ work

In his book Counselling and Psychotherapy: Newer Concepts in Practice, published in 1942, Carl Rogers presents what he sees as a new method of therapy ‘in which warmth of acceptance and absence of any form of coercion or personal pressure on the part of the counsellor permits the maximum expression of feelings, attitudes, and problems by the counsellee . . . In this unique experience of complete emotional freedom within a well-defined framework the client is free to recognise and understand his impulses and patterns, positive and negative, as in no other relationship’ (Rogers, 1942, p. 113). The book contains the first complete recorded transcript of a series of therapy sessions, with a commentary by Rogers on how the therapist’s responses in the session embodied the non-directive principles which Rogers was advocating.

During the following few years, while Rogers was based at Ohio State University, he and other therapists applied the principles of non-directive responding in a variety of contexts, including work with the adjustment problems of servicemen returning from wartime activities. It was in his next book (co-authored with John Wallen) Counselling with Returned Servicemen (1946) that Rogers first used the term ‘client-centred’, along with ‘non-directive’, as characterising his approach. It is the client’s frame of reference which is emphasised, while ‘[i]t is the counsellor’s function to provide an atmosphere in which the client, through the exploration of his situation, comes to see himself and his reactions more clearly and to accept his attitudes more fully’ (Rogers and Wallen, 1946, p. 5). What the counsellor actually did in the sessions was mainly to accompany the client with reflective restatement and clarification of what the client said, without judgement, comment or interpretation.

This work became widely known, and in 1945 Rogers accepted an invitation to a senior appointment at the prestigious University of Chicago, where he proceeded to set up a Counselling Centre which incorporated both clinical and research activities. In the following years Rogers and his colleagues continued to refine their theory and practice of ‘non-directive reflective’ psychotherapy, and in 1951 Rogers published Client-Centred Therapy. As Barrett-Lennard (1998, p. 60) points out, there are, in this work, incipient changes of emphasis in Rogers’ account. The emphasis on the therapist targeting the client’s frame of reference is still there, but this mode of responding is now seen less as a technique than as the embodiment of certain attitudes. Also in this book Rogers begins to develop a theory of the self which was needed to explain why the client-centred approach was therapeutically effective. The essentials of this theory were that as a child develops, a ‘self-structure’ or ‘self-concept’ forms in which what is valued arises partly from immediate experiencing and partly from values introjected from others, which are experienced as if they were the child’s own experience (Rogers, 1951, p. 500). As the child continues to develop, new experiences are assimilated into the self-structure or, if they are incompatible with it, are denied or distorted. Psychological disturbance is constituted by such denial or distortion. By contrast, psychological adjustment exists ‘when the concept of self is at least roughly congruent with all the experiences of the organism’ (p. 513). Any experience which is inconsistent with the self-structure is likely to be perceived as a threat, but the therapeutic situation provides a safe setting in which all the client’s experiences can be examined, and the structure of the self then becomes re-organised so as to assimilate these experiences.

Two further important concepts in client-centred therapy were developed in the mid-1950s. Rogers took up Standal’s (1954) notion of unconditional positive regard as a crucial element in effective therapy, and at the same time came to emphasise the importance of therapist ‘congruence’. The ‘congruence’ involved was that between the self as it actually is and the self as perceived. ‘Congruence’ soon came to be used rather more broadly as a synonym for ‘genuineness’, which was seen as having two aspects: those of (a) consistency between experiencing and awareness, and (b) consistency between awareness and expression. Roughly speaking, people are fully congruent if they deceive neither themselves nor others.

In 1957 Rogers published his paper ‘The necessary and sufficient conditions of therapeutic personality change’. In this he claims that just six conditions need to be obtained if there is to be therapeutic change. Three of these conditions have subsequently come to be known in client-centred writing as the ‘core conditions’ of therapy, namely the therapist conditions of empathic understanding, unconditional positive regard and congruence. The other conditions are that client and therapist are in psychological contact, that the client ‘is in a state of incongruence, being vulnerable or anxious’ (Rogers, 1957, p. 96), and that the client must register the therapist’s empathy and unconditional positive regard. I will refer to the full set of six conditions as the ‘therapeutic conditions’, and to the three conditions which the therapist needs to embody as the ‘therapist conditions’. (I prefer this latter phrase to the more familiar ‘core conditions’, since it does not misleadingly suggest that the therapist conditions are more central to therapy than the other three conditions.)

In subsequent years, much research effort was devoted to exploring the validity of Rogers’ ‘necessary and sufficient’ claim, which was a claim about not just client-centred therapy but psychotherapy in general. Prior to 1957, Fiedler’s research (Barrett-Lennard, 1998, p. 262) had already suggested that therapeutic effectiveness was correlated more with how experienced the therapists were than with their theoretical orientation. Further, work by Quinn (ibid., p. 262) suggested what seemed to characterise the experienced therapists was essentially their receptive and sensitive attitude towards their clients. Heine (ibid., p. 263) found that, regardless of the theoretical orientation of the therapist, what clients themselves found helpful were such things as ‘assisting the patient by asking questions which have the effect of clarifying feelings or attitudes’, ‘expressing for the client straight-forwardly feelings which the client approaches hesitantly and hazily’ and ‘feelings of trust, of being understood, and of independence in reaching solutions to problems’. Further, at least some of the studies conducted around this time indicated that there was a correlation between therapeutic movement and how effectively the therapist embodied the therapist conditions (ibid., pp. 82, 264–7).

In 1959 Rogers published his major theoretical paper, which explains in greater detail why the six therapeutic conditions are to be seen as causally effective. In brief, Roger’s view is that human beings have, amongst their other needs, a deep need for the positive regard of others. This need can give rise to conflict in situations where the positive regard of others is conditional upon the individual having feelings or attitudes which they do not in fact have. The individual is then in effect faced with the choice of satisfying their own ‘organismic’ needs while losing the positive regard of significant others, or of retaining the positive regard while giving up their organismic needs. The latter option, however, is not really possible since the organismic needs are there. What is possible for the individual is to deny or distort their awareness of their needs. In this way a view of themselves, a self-concept, is set up which is congruent with the ‘conditions of worth’ set by others, but incongruent with their actual experiencing. Subsequently, when life situations arise which make it difficult to maintain the distortion or denial, the person will become anxious or behave defensively, and generally exhibit some degree of psychological disturbance. Further, because greater awareness of their own experiencing will render the person liable to anxiety, he or she will be disinclined to give much attention to their experiencing. Instead of looking within to determine what they really feel or value, they will look outwards to what other people are thinking or valuing; in Rogers’ terminology they will have an ‘external locus of evaluation’. This, while reducing anxiety, undermines the person’s sense of themself as ‘solid’ and trustworthy, thus increasing the person’s sense of vulnerability.

In Rogers’ view, client-centred therapy is effective because it provides an antidote to the introjected conditions of worth: in their relationship with the therapist, the client has the experience of being seen as they are (the therapist is empathic), and of being unconditionally accepted for what they are. Further, the client experiences this empathic acceptance as being fully genuine on the therapist’s part – it is not a pretence. In these circumstances the client no longer needs to deny or distort their experiencing, so that their self-concept can return to a state of congruence with their experiencing. As a result the client’s psychological disturbance is relieved.

In the background of this account is Rogers’ notion of the ‘actualising tendency’. He held that the primary motivation of all human behaviour is the actualisation of the person’s potentialities. However, once a concept of self is set up which is at variance with the person’s organismic experiencing, self-actualisation becomes problematic. The person is torn between actualising that ‘self’ (self-concept) which is constituted by the conditions of worth (that is, becoming what one ‘should be’ in the eyes of others) and actualising their organismic potential.

Rogers sees the actualising tendency as common to all living beings. Given the right environmental conditions, an organism will grow – actualise its potentials – without the need of any outside assistance. If the environmental conditions are less favourable then the organism will still grow, but perhaps in a bizarre way. Rogers (1980, p. 118) refers to the example of potatoes which, stored in his family’s basement several feet below a small window, grew long, pale spindly sprouts as if they were seeking the light. This is not the ‘natural’ form of a potato plant; it is not the form the plant has in its natural environment. However even this distorted kind of potato is the result of the actualising tendency which moves the potato sprout to seek the light. Rogers sees this not just as an analogy for what happens in human lives, but as another example of the way in which organisms move towards actualising their potential. For human beings, as for potatoes, the environmental conditions may not be favourable or nurturing, and in that case the organism may develop an unusual form. For Rogers even the most bizarre and seemingly inappropriate forms of human behaviour are the results of the organism coping as best as it can with noxious environmental conditions. As with the potato an unnatural form of development renders the organism more vulnerable (the long potato spindles are easily broken), and there may be no way of reversing what has already happened. However, once the environmental conditions are changed (in the human case, once the conditions of worth are withdrawn) the organism will from there on be able to develop its potential more fully.

To summarise, Rogers first proposed a hypothesis, that therapeutic change will take place if and only if the six therapeutic conditions are present. I will call this the Therapeutic Conditions Hypothesis. Secondly he offered a theoretical explanation of why his hypothesis is likely to hold true, namely the Conditions of Worth Theory.

The Conditions of Worth Theory came relatively late in the evolution of client-centred therapy, some years after the client-centred practice had been established. It can look as though the theory simply emerged from the practice, but this seems unlikely, given modern views on the way scientific theories develop. In fact, Rogers’ views were deeply influenced by his knowledge of Freudian psychotherapy. He does not use the word ‘repression’, but the ‘distortion and denial of experience’ of which he speaks are recognisably close to what Freudians mean by ‘repression’. Indeed, Rogers (1951, pp. 498–503) himself makes this explicit. In connection with the internalisation of conditions of worth, Rogers uses the psychoanalytic terminology of ‘introjection’. He avoids speaking of ‘unconscious thoughts and feelings’ but this is more an avoidance of the terminology, than of the concepts. This is not to criticise Rogers; it is often worthwhile to say old things in new ways, and in addition there were many unwanted connotations of the Freudian terminology which Rogers wished to avoid. In particular, I suspect, Rogers wanted to get away from the Freudian idea that there is ‘an unconscious’ about which the therapist – armed with his theory – could know more than the client; for that idea runs counter to Rogers’ fundamental belief that the therapist’s aim should be to help the client articulate their experience in the client’s terms.

Rather than seeing Roger’s theory as simply growing out of his clinical experience I think we should see it arising from the interplay of that experience with Freudian ideas, with notions drawn from his knowledge of scientific agriculture, with ideas taken from many other thinkers. Nevertheless, it is true that Rogers’ own theory emerged only some years after the practice of what Barrett-Lennard calls ‘non-directive reflective therapy’ had evolved. This is important for one of the themes of the present book, which is that while person-centred therapy is a demonstrably effective form of therapy, there are difficulties in its theoretical formulation which have some implications for clinical practice. It is important to be able to separate the practice of non-directive reflective therapy as it evolved in the 1940s and 1950s from the theoretical explanation of its effectiveness in terms of the Conditions of Worth Theory, which Rogers presented in a fully fledged form in 1959.

I will say more about the development of Rogers’ theoretical ideas in Chapter 3, but two important points need to be made here about the later development of his thinking. One is that from the early 1960s, following his involvement in the Wisconsin schizophrenia project, Rogers came more and more to emphasise the importance of therapists being real and spontaneous in their relationships with their clients. One might say that the balance between the Therapist Conditions shifted from an emphasis on empathy and acceptance to an emphasis on genuineness. In practice this meant that client-centred practitioners were less restricted in the forms of response they might make. While previously questions, counsellor self-revelations, interpretations, suggestions and so forth were prohibited, such forms of response were now allowed so long as they were made in a way which still embodied the therapist conditions. The emphasis shifted from particular kinds of response (non-directive reflective responses) to the embodiment of particular attitudes (the therapist conditions) in whatever kinds of response came to the therapist spontaneously in the moment.

The other important aspect of Rogers’ later thinking is that from the mid-1960s he became very much involved in working with groups. It was the time at which ‘encounter groups’ were becoming very popular in North America, and Rogers’ interest was caught by the fact that the conditions which facilitated group understanding and co-operation seemed to be very much the same as the conditions which were facilitative in individual therapy. In the succeeding years nearly all of Rogers’ professional energy was devoted to this new interest, and he wrote nothing significantly new in connection with counselling theory. Rogers’ own enthusiasm for groups, together perhaps with something in the spirit of the times, led to a strong emphasis on unstructured group-work in the world of person-centred counselling, regardless of whether it was appropriate to the context. Mearns (1997, p. 11) recalls some of the more extreme examples of this trend, such as the trainer who ‘began his weekend introductory course in person-centred counselling skills with a time-unlimited, unstructured encounter group without giving any warning or explanation’. Such episodes are less common today, although many people become interested in ‘the person-centred approach’ through encounter with person-centred group-work, and are sometimes surprised to learn that it was not in this context that Rogers’ ideas originated.

Paths of development in PCT

In the years following the establishment of client-centred therapy as a distinctive school, several lines of development can be traced. I will briefly discuss each of these, with a view to seeing later how focusing-oriented therapy fits into the wider picture. Some of these alternative views within the broad spectrum of the person-centred tradition will be familiar to readers who come to person-centred therapy in what might be called the standard way, that is, through the writings of Rogers, and the experience of training courses which emphasise the centrality of the therapist conditions. Other views may be less familiar, and I will devote more space to some of these. In Britain, especially, there has been little awareness of how many distinct ‘tribes’ there are in the person-centred ‘nation’ (Warner, 2000a), although this situation is now beginning to change (Sanders, 2004).

The standard view

By ‘the standard view’ I mean the view of person-centred therapy which is set out in widely read books which frequently appear as ‘recommended reading’ on person-centred training courses. Examples of such books are Dave Mearns’ and Brian Thorne’s Person-Centred Counselling in Action (1988; second edition 1999), Tony Merry’s Learning and Being in Person-Centred Couns...

Table of contents

• Cover
• Title Page
• Copyright
• Dedication
• Contents
• Acknowledgements
• Terminological Note
• Introduction
• 1. Rogers and the Development of Person-Centred Therapy
• 2. Fault-Lines in Person-Centred Theory
• 3. The Origins of Focusing
• 4. Focusing as a Taught Procedure
• 5. Focusing-Oriented Psychotherapy
• 6. Objections: Issues of Principle and Empirical Issues
• 7. Training and Supervision
• 8. Towards a Theory of Psychotherapy
• Conclusion
• Appendix A: The Wider Context
• Appendix B: Resources
• References
• Index